Introduction:Little is known about the perception and use of e-cigarettes by the
Chinese, particularly the young people. This study reveals the awareness, attitudes,
and use of e-cigarettes among young adults in China, examines the relationship
between smoking behavior and e-cigarette perception and use, and demonstrates
the phenomenon of e-cigarette gifting.

Methods:We used results from a mobile app-based survey conducted in November
2015 that included 10477 young Chinese adults aged between 19 and 29 years.
Bivariate tests were conducted to analyze perception and use of e-cigarettes by
respondents of different smoking status. Multivariate logistic regressions were
applied to examine the correlates of e-cigarette use and perception and e-cigarette
gifting behavior, particularly the factors of tobacco smoking status and quitting
behavior.

Results:Among the surveyed young adults, 88.40% were aware of e-cigarettes,
and nearly a quarter of all respondents had used e-cigarettes by the time of our
survey. Multivariate regression results demonstrated that current smokers with
quitting experience were more likely to be aware of and to use e-cigarettes than
current smokers with no quitting experience. Smokers with quitting experience
also were more inclined to promote e-cigarettes to others by either recommending
them or giving them as gifts.

Conclusions:E-cigarettes have gained popularity among young adults in China
and smokers, especially those who had tried quitting, were more likely to have
known and used e-cigarettes. More empirical research on the relationship between
e-cigarette use and smoking cessation is warranted to better inform a potential
regulatory framework in China.

CONFLICTS OF INTEREST

The authors have completed and submitted an ICMJE form for
disclosure of potential conflicts of interest and they declare that they
have no competing interests, financial or otherwise, related to the
current work. X Wang, X Zhang, X Xu and Y Gao report grants from
the Bill and Melinda Gates Foundation, during the conduct of the study.

FUNDING

This study was supported by the Bill and Melinda Gates Foundation
(Grant number OPP1123586). The funder had no role in the study
design, collection, analysis, or interpretation of the data, writing the
manuscript, or the decision to submit the paper for publication. The
corresponding author had full access to all data in the study and had
final responsibility for the decision to submit the paper for publication.

Zhang X, Lin S, Hu T-w. The epidemic of cigarette gifting: A social barrier of tobacco control in China. In: Hu T-w, ed. Economics of bobacco control in China: From policy research to practice. Hackensack, NJ: World Scientific; 2016:129-146.